Design of the body

Duke Federico da Montefeltro had to redesign part of his body. A mercenary in Renaissance Italy, he lost the sight of one eye in a joust, and so asked his surgeon to remove part of the bridge of his nose so that his remaining eye would have a wider field of vision, something that he considered essential in combat. A wholly functional retouch, even though the Duke was so proud of his new nose that from then on, all his portraits were in profile.Today, the design of the human body has become accessible to everyone, with procedures ranging from tattoos and piercing to complex aesthetic surgery. To learn more about the new frontiers of plastic surgery, we spoke to Dr. Ivan Tome de Arruda, who works principally in Milan, Italy.

Dr Arruda, what is your approach to the design of the human body?The important thing is to avoid over-correction. If a patient wants a smaller nose, and the result looks too small for the face, the final result can look very strange. I try to attain results that are possible in nature, rather than aiming for things that do not exist.

How do you account for the fact that the ideal of beauty has changed over the centuries?Today the type of beauty that most people aspire to is an athletic body, in part because it is associated with health. In the past, women had to be much rounder to be considered really attractive, as can be seen in painting and sculpture. But in those days, survival was linked to having enough to eat. Today, survival is more about a healthy lifestyle.

Does the approach of your patients to the redesign of their body depend on how they see themselves?That’s right. People are not objective when they look at themselves. When patients come into my studio, they already know what they want. For example, they may be worried about the bags under their eyes, when in actual fact their nose has a far more detrimental effect on their appearance. I try to give them tactful advice.

Design is a combination of art and technology. Would you say that your profession is a combination of art and surgery?Yes, it is art, hand-in-hand with medical techniques, which are developing rapidly. Today, surgical procedures are simpler, made with far smaller incisions, and often on day patients. In the future, it could be that the tissue needed for augmentation mammoplasty is grown in vitro using stem cells taken from the patient herself. It is likely that biotechnology will make silicone implants a thing of the past. But this is still a long way off.

Some say that the evolution of the human species has come to a halt, because there is no longer any natural selection. Would you say that plastic surgery is a new type of evolution, designed by man and not by nature?It’s a form of human evolution, but it is linked to the social sphere and not to biology. People use plastic surgery to improve their position in society, and to be more successful in life. This is an accelerating trend, because plastic surgery is becoming increasingly accessible.

When you are talking about the new design of your patients, how do you help them visualize the final result? Do you make sketches?There are some computer programmes that can show the results of a surgical operation. But personally I think that they are used more for marketing, rather than as a design tool. It’s like going to the hair stylist: he can show you photos of a model with long, flowing locks, but the final result depends on your own hair! I prefer to show a patient photos of the results that I have attained on patients in a similar situation.

Once it’s all over and the scars have healed, how many people are completely happy with their new design?About 80%. There are always people who are never happy, and there is a pathology called body dysmorphic disorder in which people are constantly worried about their appearance. They can only see their presumed defects. When dysmorphia is combined with wealth, it becomes very dangerous, because they’re always thinking of their next operation. And in the end they risk ending up with a body that looks totally unnatural, as if they were man-made aliens.

Design has a lot in common with fashion. Are there trends that come and go in plastic surgery?Yes. About ten years ago, when I arrived in Italy, there was the fashion of lip augmentation and mammoplasty, but today, the trend is towards more moderate-sized lips and breasts.

Would you say that your patients are concerned not just with attaining beauty, but above with staying beautiful for longer?Exactly. Beauty, for longer. A person who has experienced the benefits from being considered beautiful – and let’s be honest, beauty opens doors – finds it distressing when their looks begin to deteriorate, when they receive fewer invitations, when the praise is more for their daughter than for them. It’s at that point that they go to the surgeon. They want him to give them back that power.